The recently published Acute Care Competencies (ACC) identify important benchmarks for entry level physical therapy practice in the domains of clinical reasoning, patient management, safety, communication and discharge planning. Due to the team based nature of the acute/inpatient setting, interprofessional collaborative practice, specifically communication, is key to safe, efficient and effective patient care. Although the ACC were developed for the acute/inpatient settings, these skills are necessary for physical therapists across practice settings. Shortly before the ACC were published, the University of Colorado Doctor of Physical Therapy (DPT) Program underwent a curricular revision. Based on anecdotal feedback from clinical instructors (CI) and student exit interviews, the musculoskeletal (MSK) faculty performed a gap analysis regarding student preparation for the acute care setting. Using the ACC as a guide, the MSK faculty recognized that didactic and experiential content addressing several domains were lacking and/or inadequate to bridge the translation to clinical performance. These gaps were supported by CI reports of student challenges in examination prioritization, treatment progression, discharge planning, synthesizing and prioritizing medical record information, and interprofessional communication. To address the gaps, the MSK faculty expanded didactic and experiential content to improve student knowledge, confidence, and competence in working with patients across the continuum of care.
Methods and/or Description of Project
The expanded content was delivered in the third and final MSK track course prior to the second full-time clinical experience in year two of the DPT curriculum. Curricular revisions included one additional lecture and three lab experiences incorporated into a geriatric MSK management module. To prepare students for the lecture on geriatric and inpatient MSK patient care, the ACC were required reading and were elucidated in a class discussion. To develop a stronger student understanding and application, a scaffolding instructional technique was used to develop the lab learning activities. The initial lab consisted of student observation of a simulated patient examination followed by student reflection, pairing and sharing of observations in response to guiding clinical reasoning questions. This experience was followed by a case-based, small group problem solving of treatment progression and structured report outs of discharge plans to an interprofessional team. The third lab included standardized patient (SP) examinations and interventions for cases in the acute hospital, inpatient rehab, and adult home health settings. The primary goal for the SP lab was for students to independently perform an initial examination and intervention with focus on synthesis and integration of medical record information and subjective history from the patient, family, and/or team members. To facilitate team communication and information handoffs, nursing students were incorporated into the SP encounters. Following these encounters, faculty led debriefing sessions consisting of self-assessment and student/peer reflections and feedback.
The effectiveness of curricular revisions was assessed through standard course evaluations, student and clinical preceptor surveys, and post-clinical education focus groups. Course evaluations and focus groups were overwhelmingly positive about the SP experiential lab addition. A pre- and post-course survey regarding student confidence in the five competency domains was completed, with response rates of 46% and 62% respectively. A three question survey regarding the impact of the nursing student collaboration was used with a response rate of 45%. Student confidence was most enhanced in understanding the roles and responsibilities of the inpatient physical therapist, communication and discharge planning. Ninety-three percent of students reported the nursing collaboration in the simulation lab either “somewhat or significantly” enhanced learning. Specifically, students thought the nursing collaboration improved their ability to exchange patient specific information, and all respondents recommended its continuation. To begin to understand how the ACC can guide clinical education experiences, CIs from IP settings were asked: 1) about their awareness of the ACC and 2) whether they use the competencies as a tool to design learning experiences in the clinic. Fifty-three percent of CIs were aware of the ACC, and only 50% of those aware used them to design student learning experiences.
Conclusions/Relevance to the conference theme: Through the Looking Glass: Transforming Physical Therapy Education
These curricular additions were transformational in providing important opportunities for DPT students to review and apply psychomotor skills, enhance clinical reasoning, and practice interprofessional communication in simulated clinical scenarios. Students felt these experiences integrated well with and enhanced their interprofessional education courses, which span all health professions. Although clinical experiences provide vital learning experiences, the didactic course additions maintained or increased student confidence in the ACC immediately prior to the next clinical experience. Opportunities exist for DPT programs to promote awareness of the ACC and to encourage their utility in designing learning experiences for students in the acute care and other inpatient settings. In addition, the ACC can serve as benchmarks for practitioners and can be embedded in the new graduate mentoring process. Future directions include the addition of other rehabilitation professions into the lab experiences, further practice with medical record synthesis and prioritization, and improvement in linking of student survey responses with prior clinical experience settings.
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Upon completion of this course, participants will be able to:
1. Describe the use of the acute care competencies to inform curriculum development.
2. Evaluate current curriculum for possible gaps in preparing students for acute/inpatient practice.
3. Develop intentional learning experiences to address the identified gaps.
4. Strategize ways to educate clinical instructors on the acute care competencies.
5. Strategize ways the acute care competencies can inform student learning during clinical experiences.
1. Lecture Presentation
2. Audience polling regarding use of acute care competencies in current curriculum
3. Small group problem solving on learning strategies to address the competencies
10 minutes: Background on Core Competencies and Current DPT Curriculum
15 minutes: Discussion of Gap Analysis in Revision of New Curriculum and Development of New Curricular Elements
20 minutes: Implementation of Curricular Additions and Evolution
10 minutes: Outcomes Assessment and Analysis
5 minutes: Next Steps in Curricular Enhancement
20 minutes: Active Learning Activity
10 minutes: Conclusion; Q/A